Quitting smoking abruptly is more effective than doing it gradually, study finds

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At the four-week mark, 39 percent of the participants in the gradual-cessation group were still not smoking compared to 49 percent of those who quit abruptly.

When I quit smoking in my early 20s, I did it abruptly. I picked a date, and told myself I wouldn’t smoke another cigarette from that day forward. Ever again.

And I haven’t. But I still remember, all these years later, how agonizingly difficult those first few months of abstinence were. I also remember thinking at the time that there must be a better way of giving up smoking than by going cold turkey.

Well, apparently there isn’t, at least not according to a study published Tuesday in the Annals of Internal Medicine. Using the gold standard of research — a randomized controlled trial — British researchers have found that quitting smoking “overnight” is a significantly more effective strategy than “cutting down gradually.”

They reached this conclusion even though their hypothesis at the start of the study was that the gradual approach would not be inferior.

Study details

For the study, which was conducted from June 2009 to December 2011, the researchers recruited 796 people who smoked at least 15 cigarettes a day and who were willing to quit smoking two weeks after enrollment in the study. The smokers were randomized into two groups. One — the “abrupt cessation” group — was instructed to stop all smoking on the quit day. The other — the “gradual cessation” group — was instructed to lead up to the quit day by reducing their smoking by 50 percent during the first week and by 25 percent during the second.

Both groups were provided with advice and support to help them quit smoking. They were also given access to long-acting nicotine patches and various short-acting nicotine replacement therapies, such as nicotine gum and mouth spray.

The participants were assessed weekly for four weeks after the quit day, and then again at six months. At each assessment they were asked how they were doing in terms of quitting, including whether they were experiencing any symptoms of nicotine withdrawal. To obtain an objective determination of the participants’ progress, the researchers also measured the amount of carbon monoxide they exhaled and the amount of cotinine in their saliva. (Cotinine is a marker for exposure to tobacco smoke.)

Basic findings

At the four-week mark, 39 percent of the participants in the gradual-cessation group were still not smoking compared to 49 percent of those who quit abruptly.

At six months, 15.5 percent of the people in the gradual-cessation group were still not smoking compared to 22 percent of those who quit abruptly.

Interestingly, the difference between the groups was apparent from the start: On the quit day, more people in the abrupt-cessation group made the effort to give up smoking (abstaining for at least 24 hours) than in the gradual-cessation group.

“The difference in quit attempts seemed to arise because people struggled to cut down,” said Nicola Lindson-Hawley, the study’s lead author and a tobacco cessation researcher at the University of Oxford, in a released statement. “It provided them with an extra thing to do, which may have put them off quitting altogether. If people actually made a quit attempt then the success rate was equal across groups.”

“We also found that more people preferred the idea of quitting gradually than abruptly,” she added. “However, regardless of what they thought, they were still more likely to quit in the abrupt group.”

Strengths and limitations

This study had several important strengths, including its relatively large number of participants (which cuts down on the possibility that the results were just the result of chance) and its extension of the follow-up period to six months. In addition, the characteristics of the study’s two randomized groups were well balanced. Both groups had a similar average age (49 years), were equally split between men and women and scored similarly on a nicotine dependence test.

But the study also had some limitations. Most notably, more than 94 percent of the participants were white, and all, of course, lived in the U.K. Smoking cessation approaches might lead to different results in other, more ethnically and racially diverse populations.

Although this study found that abrupt quitting is the more effective method, the authors point out that gradual cessation strategies “could still be worthwhile if they increase the number of persons who try to quit or take up support and medication while trying.”

The important thing is, of course, to set a quit day and then to put into place whatever strategies you need to improve your chances of quitting. Many health organizations are ready to offer you resources and support. A great place to start is with Minnesota’s free QUITPLAN program.

Comments (5)

I quit a two carton a week habit abruptly. I planned my day, filled a patch prescription, signed up for a class. I arrived home from a vacation, slapped on a patch and unpacked my car. It takes a commitment and a plan to get through those initial uncomfortable days and weeks.

Re: “Both groups received behavioral support from nurses and used nicotine replacement before and after quit day.”

Nobody in this study was asked to quit “cold turkey” if they used nicotine replacement. From Wikipedia, “Smoking cessation methods advanced by J. Wayne McFarland and Elman J. Folkenburg (an M.D. and a pastor who wrote their Five Day Plan ca. 1959), Joel Spitzer and John R. Polito (smoking cessation educators) and Allen Carr (who founded Easyway during the early 1980s) are cold turkey plans.”https://en.wikipedia.org/wiki/Cold_turkey

I quit smoking at about 6 PM on February 3, 1990, when I ran out of cigarettes on a miserable, cold Saturday night. I’d smoked for 29 years, and was at the point where I consumed nearly 2 packs a day. I was also enrolled and participating in an employer-sponsored “Quit Smoking” program, and under the terms of that program, I could have continued for another week. We weren’t scheduled to quit until the next Friday. For me, it was a control issue.

I started because my older stepbrother smoked, and it seemed like a cool thing to do to a gangly high school freshman – a status thing. Many years later, I quit for two reasons: first, because I was developing that morning cough that so many smokers develop, and couldn’t persuade myself that smoking was somehow healthy; and second, because I bristled at the idea that some program director was going to tell me when to quit. I wanted to be the one to determine when and where I quit. Think of it as “the oldest child” syndrome – I was used to being self-directed.

I had no plan in advance, and there was no “nicotine replacement” therapy or counseling. I did have a very thoughtful colleague who, though he continued to smoke, went to another employee lounge to do so until, a couple weeks later, I could tell him honestly that I wasn’t tempted to join him. I didn’t tell him that, once I’d quit, I found tobacco smoke annoying and irritating, but thankfully, he cut back on his smoking while sitting at the table with me, which helped quite a bit. That was the only “outside” help available.

I was miserable the remainder of that weekend, and the first day back at work, but after those first 3 days, the nicotine craving decreased dramatically, and I’ve never been tempted to go back to smoking since. I don’t proselytize about it, but am nonetheless happy to see that the anti-smoking campaign has enjoyed increasing degrees of success. I don’t think “shaming” smokers is very effective, but treating smoking as a public health issue seems to work better.

My mother, a 25 year smoker finally decided she had enough and used hypnosis to quit. One day a smoker, the next not. She was also very head strong, so that may be part of it, but for the rest of the family – it worked brilliantly. She did however cluck like a chicken when ever anybody said Viceroy (her brand)